facebookuserprivacysettlement.com Open in urlscan Pro
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POST

<form class="needs-validation" id="form" method="post">
  <h3 class="text-center mb-3" id="claimFormDeadline">The deadline for submitting this Claim Form is<br><span id="deadline_datetime">August 25, 2023 at 11:59 PM</span> PT</h3>
  <div class="alert alert-info text-center fw-bold text-dark" id="confirmation-email-alert" role="alert">Please add the email, <span class="fst-italic">Confirmation@FacebookUserPrivacySettlement.com</span>, to your contact list to ensure that future
    correspondence is delivered to your inbox.</div>
  <div class="mb-3" id="generalInstructionsWrapper">
    <div class="text-center fw-bold fs-3"><a class="" data-bs-toggle="collapse" href="#generalInstructions" aria-expanded="false" aria-controls="generalInstructions">Click for General Instructions</a></div>
    <div class="collapse" id="generalInstructions">
      <div class="bg-light text-dark border rounded p-3 mb-3">
        <p>This Claim Form is for Settlement Class Members. The Settlement Class includes the following: All Facebook users in the United States between May 24, 2007 and December 22, 2022. To receive a payment from the Settlement, you must complete
          and submit this form.</p>
        <p class="fw-bold text-center">How To Complete This Claim Form</p>
        <ol>
          <li class="mb-3">There are two ways to submit this Claim Form to the Settlement Administrator: (a) online on this website; or (b) by U.S. Mail to the following address: Facebook Consumer Privacy User Profile Litigation, c/o Settlement
            Administrator, 1650 Arch Street, Suite 2210, Philadelphia, PA 19103. Your Claim Form must be submitted by <strong>August 25, 2023</strong>. If you submit your claim by U.S. mail, make sure the completed and signed Claim Form is postmarked
            by <strong>August 25, 2023</strong>.</li>
          <li class="mb-3">You must complete the entire Claim Form. Please type or write your responses legibly. </li>
          <li class="mb-3">If your Claim Form is incomplete or missing information, the Settlement Administrator may contact you for additional information. If you do not respond by the deadline provided by the Settlement Administrator for you to
            supply any such additional information, your claim will not be processed, and you will waive your right to receive money under the Settlement.</li>
          <li class="mb-3">You may only submit one Claim Form.</li>
          <li class="mb-3">Submission of the Claim Form does not guarantee payment. Your Claim Form must be approved by the Settlement Administrator.</li>
          <li class="mb-3">If you have any questions, please contact the Settlement Administrator by email at <a href="mailto:info@FacebookUserPrivacySettlement.com">info@FacebookUserPrivacySettlement.com</a>, by telephone at
            <a href="tel:+1-855-556-2233">1-855-556-2233</a> or by U.S. mail at the address listed above.</li>
          <li class="mb-3 fw-bold">You must notify the Settlement Administrator if your contact or payment information changes after you submit your Claim Form. If you do not, even if you submit a valid claim under the Settlement, you may not receive
            your Settlement payment.</li>
          <li class="mb-3"><strong>DEADLINE</strong> -- If you submit a claim by U.S. mail, the completed and signed Claim Form must be postmarked by <strong>August 25, 2023</strong>. If submitting a Claim Form online, you must do so by
            <strong>August 25, 2023 at 11:59 p.m. PDT</strong>.</li>
        </ol>
      </div>
    </div>
  </div>
  <fieldset class="bg-light text-dark border rounded p-3 mb-5" id="contact-information">
    <legend class="mb-3">Your Contact Information</legend>
    <p class="mb-3"></p>
    <p>Provide your name and contact information below. You must notify the Settlement Administrator if your contact information changes after you submit this form. NOTE: The personal information you provide below will be processed only for purposes
      of effectuating the Settlement.</p>
    <div class="text-danger fw-bold">* Required Fields</div>
    <p></p>
    <div class="row row-cols-1 row-cols-md-2">
      <div class="col mb-3 divContactField" id="divContactField_0"><label for="first_name">First Name* <span class="error"></span></label><input type="text" name="first_name" class="form-control" id="first_name" placeholder=""
          data-validate="required" data-contact-label="First Name"></div>
      <div class="col mb-3 divContactField" id="divContactField_1"><label for="last_name">Last Name* <span class="error"></span></label><input type="text" name="last_name" class="form-control" id="last_name" placeholder="" data-validate="required"
          data-contact-label="Last Name"></div>
      <div class="col mb-3 divContactField" id="divContactField_2"><label for="street_address_1">Street Address 1* <span class="error"></span></label><input type="text" name="street_address_1" class="form-control" id="street_address_1" placeholder=""
          data-validate="required" data-contact-label="Street Address 1"></div>
      <div class="col mb-3 divContactField" id="divContactField_3"><label for="street_address_2">Street Address 2 <span class="error"></span></label><input type="text" name="street_address_2" class="form-control" id="street_address_2" placeholder=""
          data-validate="" data-contact-label="Street Address 2"></div>
      <div class="col mb-3 divContactField" id="divContactField_4"><label for="city">City* <span class="error"></span></label><input type="text" name="city" class="form-control" id="city" placeholder="" data-validate="required"
          data-contact-label="City"></div>
      <div class="col mb-3 divContactField" id="divContactField_5"><label for="state">State* <span class="error"></span></label><select name="state" class="form-control" id="state" data-validate="required" data-contact-label="State">
          <option value="">SELECT</option>
          <option value="AL">Alabama</option>
          <option value="AK">Alaska</option>
          <option value="AZ">Arizona</option>
          <option value="AR">Arkansas</option>
          <option value="CA">California</option>
          <option value="CO">Colorado</option>
          <option value="CT">Connecticut</option>
          <option value="DE">Delaware</option>
          <option value="DC">District Of Columbia</option>
          <option value="FL">Florida</option>
          <option value="GA">Georgia</option>
          <option value="HI">Hawaii</option>
          <option value="ID">Idaho</option>
          <option value="IL">Illinois</option>
          <option value="IN">Indiana</option>
          <option value="IA">Iowa</option>
          <option value="KS">Kansas</option>
          <option value="KY">Kentucky</option>
          <option value="LA">Louisiana</option>
          <option value="ME">Maine</option>
          <option value="MD">Maryland</option>
          <option value="MA">Massachusetts</option>
          <option value="MI">Michigan</option>
          <option value="MN">Minnesota</option>
          <option value="MS">Mississippi</option>
          <option value="MO">Missouri</option>
          <option value="MT">Montana</option>
          <option value="NE">Nebraska</option>
          <option value="NV">Nevada</option>
          <option value="NH">New Hampshire</option>
          <option value="NJ">New Jersey</option>
          <option value="NM">New Mexico</option>
          <option value="NY">New York</option>
          <option value="NC">North Carolina</option>
          <option value="ND">North Dakota</option>
          <option value="OH">Ohio</option>
          <option value="OK">Oklahoma</option>
          <option value="OR">Oregon</option>
          <option value="PA">Pennsylvania</option>
          <option value="RI">Rhode Island</option>
          <option value="SC">South Carolina</option>
          <option value="SD">South Dakota</option>
          <option value="TN">Tennessee</option>
          <option value="TX">Texas</option>
          <option value="UT">Utah</option>
          <option value="VT">Vermont</option>
          <option value="VA">Virginia</option>
          <option value="WA">Washington</option>
          <option value="WV">West Virginia</option>
          <option value="WI">Wisconsin</option>
          <option value="WY">Wyoming</option>
          <option value="PR">Puerto Rico</option>
          <option value="GU">Guam</option>
          <option value="AS">American Samoa</option>
          <option value="MP">Northern Mariana Islands</option>
          <option value="VI">U.S. Virgin Islands</option>
          <option value="AA">AA (Armed Forces Americas)</option>
          <option value="AE">AE (Armed Forces Europe)</option>
          <option value="AP">AP (Armed Forces Pacific)</option>
        </select></div>
      <div class="col mb-3 divContactField d-none" id="divContactField_6"><label for="province">Province <span class="error"></span></label><input type="text" name="province" class="form-control" id="province" placeholder="" data-validate=""
          data-contact-label="Province"></div>
      <div class="col mb-3 divContactField" id="divContactField_7"><label for="zip_code">Zip Code* <span class="error"></span></label><input type="text" name="zip_code" class="form-control" id="zip_code" placeholder=""
          data-validate="required zip-code" data-contact-label="Zip Code"></div>
      <div class="col mb-3 divContactField d-none" id="divContactField_8"><label for="postal_code">Postal Code <span class="error"></span></label><input type="text" name="postal_code" class="form-control" id="postal_code" placeholder=""
          data-validate="" data-contact-label="Postal Code"></div>
      <div class="col mb-3 divContactField" id="divContactField_9"><label for="country">Country* <span class="error"></span></label><select name="country" class="form-control" id="country" data-validate="required" data-contact-label="Country">
          <option value="">SELECT</option>
          <option value="USA">United States</option>
          <option value="AFG">Afghanistan</option>
          <option value="ALA">Åland Islands</option>
          <option value="ALB">Albania</option>
          <option value="DZA">Algeria</option>
          <option value="ASM">American Samoa</option>
          <option value="AND">Andorra</option>
          <option value="AGO">Angola</option>
          <option value="AIA">Anguilla</option>
          <option value="ATA">Antarctica</option>
          <option value="ATG">Antigua and Barbuda</option>
          <option value="ARG">Argentina</option>
          <option value="ARM">Armenia</option>
          <option value="ABW">Aruba</option>
          <option value="AUS">Australia</option>
          <option value="AUT">Austria</option>
          <option value="AZE">Azerbaijan</option>
          <option value="BHS">Bahamas</option>
          <option value="BHR">Bahrain</option>
          <option value="BGD">Bangladesh</option>
          <option value="BRB">Barbados</option>
          <option value="BLR">Belarus</option>
          <option value="BEL">Belgium</option>
          <option value="BLZ">Belize</option>
          <option value="BEN">Benin</option>
          <option value="BMU">Bermuda</option>
          <option value="BTN">Bhutan</option>
          <option value="BOL">Bolivia, Plurinational State of</option>
          <option value="BES">Bonaire, Sint Eustatius and Saba</option>
          <option value="BIH">Bosnia and Herzegovina</option>
          <option value="BWA">Botswana</option>
          <option value="BVT">Bouvet Island</option>
          <option value="BRA">Brazil</option>
          <option value="IOT">British Indian Ocean Territory</option>
          <option value="BRN">Brunei Darussalam</option>
          <option value="BGR">Bulgaria</option>
          <option value="BFA">Burkina Faso</option>
          <option value="BDI">Burundi</option>
          <option value="KHM">Cambodia</option>
          <option value="CMR">Cameroon</option>
          <option value="CAN">Canada</option>
          <option value="CPV">Cape Verde</option>
          <option value="CYM">Cayman Islands</option>
          <option value="CAF">Central African Republic</option>
          <option value="TCD">Chad</option>
          <option value="CHL">Chile</option>
          <option value="CHN">China</option>
          <option value="CXR">Christmas Island</option>
          <option value="CCK">Cocos (Keeling) Islands</option>
          <option value="COL">Colombia</option>
          <option value="COM">Comoros</option>
          <option value="COG">Congo</option>
          <option value="COD">Congo, the Democratic Republic of the</option>
          <option value="COK">Cook Islands</option>
          <option value="CRI">Costa Rica</option>
          <option value="CIV">Côte d'Ivoire</option>
          <option value="HRV">Croatia</option>
          <option value="CUB">Cuba</option>
          <option value="CUW">Curaçao</option>
          <option value="CYP">Cyprus</option>
          <option value="CZE">Czech Republic</option>
          <option value="DNK">Denmark</option>
          <option value="DJI">Djibouti</option>
          <option value="DMA">Dominica</option>
          <option value="DOM">Dominican Republic</option>
          <option value="ECU">Ecuador</option>
          <option value="EGY">Egypt</option>
          <option value="SLV">El Salvador</option>
          <option value="GNQ">Equatorial Guinea</option>
          <option value="ERI">Eritrea</option>
          <option value="EST">Estonia</option>
          <option value="ETH">Ethiopia</option>
          <option value="FLK">Falkland Islands (Malvinas)</option>
          <option value="FRO">Faroe Islands</option>
          <option value="FJI">Fiji</option>
          <option value="FIN">Finland</option>
          <option value="FRA">France</option>
          <option value="GUF">French Guiana</option>
          <option value="PYF">French Polynesia</option>
          <option value="ATF">French Southern Territories</option>
          <option value="GAB">Gabon</option>
          <option value="GMB">Gambia</option>
          <option value="GEO">Georgia</option>
          <option value="DEU">Germany</option>
          <option value="GHA">Ghana</option>
          <option value="GIB">Gibraltar</option>
          <option value="GRC">Greece</option>
          <option value="GRL">Greenland</option>
          <option value="GRD">Grenada</option>
          <option value="GLP">Guadeloupe</option>
          <option value="GUM">Guam</option>
          <option value="GTM">Guatemala</option>
          <option value="GGY">Guernsey</option>
          <option value="GIN">Guinea</option>
          <option value="GNB">Guinea-Bissau</option>
          <option value="GUY">Guyana</option>
          <option value="HTI">Haiti</option>
          <option value="HMD">Heard Island and McDonald Islands</option>
          <option value="VAT">Holy See (Vatican City State)</option>
          <option value="HND">Honduras</option>
          <option value="HKG">Hong Kong</option>
          <option value="HUN">Hungary</option>
          <option value="ISL">Iceland</option>
          <option value="IND">India</option>
          <option value="IDN">Indonesia</option>
          <option value="IRN">Iran, Islamic Republic of</option>
          <option value="IRQ">Iraq</option>
          <option value="IRL">Ireland</option>
          <option value="IMN">Isle of Man</option>
          <option value="ISR">Israel</option>
          <option value="ITA">Italy</option>
          <option value="JAM">Jamaica</option>
          <option value="JPN">Japan</option>
          <option value="JEY">Jersey</option>
          <option value="JOR">Jordan</option>
          <option value="KAZ">Kazakhstan</option>
          <option value="KEN">Kenya</option>
          <option value="KIR">Kiribati</option>
          <option value="PRK">Korea, Democratic People's Republic of</option>
          <option value="KOR">Korea, Republic of</option>
          <option value="KWT">Kuwait</option>
          <option value="KGZ">Kyrgyzstan</option>
          <option value="LAO">Lao People's Democratic Republic</option>
          <option value="LVA">Latvia</option>
          <option value="LBN">Lebanon</option>
          <option value="LSO">Lesotho</option>
          <option value="LBR">Liberia</option>
          <option value="LBY">Libya</option>
          <option value="LIE">Liechtenstein</option>
          <option value="LTU">Lithuania</option>
          <option value="LUX">Luxembourg</option>
          <option value="MAC">Macao</option>
          <option value="MKD">Macedonia, the former Yugoslav Republic of</option>
          <option value="MDG">Madagascar</option>
          <option value="MWI">Malawi</option>
          <option value="MYS">Malaysia</option>
          <option value="MDV">Maldives</option>
          <option value="MLI">Mali</option>
          <option value="MLT">Malta</option>
          <option value="MHL">Marshall Islands</option>
          <option value="MTQ">Martinique</option>
          <option value="MRT">Mauritania</option>
          <option value="MUS">Mauritius</option>
          <option value="MYT">Mayotte</option>
          <option value="MEX">Mexico</option>
          <option value="FSM">Micronesia, Federated States of</option>
          <option value="MDA">Moldova, Republic of</option>
          <option value="MCO">Monaco</option>
          <option value="MNG">Mongolia</option>
          <option value="MNE">Montenegro</option>
          <option value="MSR">Montserrat</option>
          <option value="MAR">Morocco</option>
          <option value="MOZ">Mozambique</option>
          <option value="MMR">Myanmar</option>
          <option value="NAM">Namibia</option>
          <option value="NRU">Nauru</option>
          <option value="NPL">Nepal</option>
          <option value="NLD">Netherlands</option>
          <option value="NCL">New Caledonia</option>
          <option value="NZL">New Zealand</option>
          <option value="NIC">Nicaragua</option>
          <option value="NER">Niger</option>
          <option value="NGA">Nigeria</option>
          <option value="NIU">Niue</option>
          <option value="NFK">Norfolk Island</option>
          <option value="MNP">Northern Mariana Islands</option>
          <option value="NOR">Norway</option>
          <option value="OMN">Oman</option>
          <option value="PAK">Pakistan</option>
          <option value="PLW">Palau</option>
          <option value="PSE">Palestinian Territory, Occupied</option>
          <option value="PAN">Panama</option>
          <option value="PNG">Papua New Guinea</option>
          <option value="PRY">Paraguay</option>
          <option value="PER">Peru</option>
          <option value="PHL">Philippines</option>
          <option value="PCN">Pitcairn</option>
          <option value="POL">Poland</option>
          <option value="PRT">Portugal</option>
          <option value="PRI">Puerto Rico</option>
          <option value="QAT">Qatar</option>
          <option value="REU">Réunion</option>
          <option value="ROU">Romania</option>
          <option value="RUS">Russian Federation</option>
          <option value="RWA">Rwanda</option>
          <option value="BLM">Saint Barthélemy</option>
          <option value="SHN">Saint Helena, Ascension and Tristan da Cunha</option>
          <option value="KNA">Saint Kitts and Nevis</option>
          <option value="LCA">Saint Lucia</option>
          <option value="MAF">Saint Martin (French part)</option>
          <option value="SPM">Saint Pierre and Miquelon</option>
          <option value="VCT">Saint Vincent and the Grenadines</option>
          <option value="WSM">Samoa</option>
          <option value="SMR">San Marino</option>
          <option value="STP">Sao Tome and Principe</option>
          <option value="SAU">Saudi Arabia</option>
          <option value="SEN">Senegal</option>
          <option value="SRB">Serbia</option>
          <option value="SYC">Seychelles</option>
          <option value="SLE">Sierra Leone</option>
          <option value="SGP">Singapore</option>
          <option value="SXM">Sint Maarten (Dutch part)</option>
          <option value="SVK">Slovakia</option>
          <option value="SVN">Slovenia</option>
          <option value="SLB">Solomon Islands</option>
          <option value="SOM">Somalia</option>
          <option value="ZAF">South Africa</option>
          <option value="SGS">South Georgia and the South Sandwich Islands</option>
          <option value="SSD">South Sudan</option>
          <option value="ESP">Spain</option>
          <option value="LKA">Sri Lanka</option>
          <option value="SDN">Sudan</option>
          <option value="SUR">Suriname</option>
          <option value="SJM">Svalbard and Jan Mayen</option>
          <option value="SWZ">Swaziland</option>
          <option value="SWE">Sweden</option>
          <option value="CHE">Switzerland</option>
          <option value="SYR">Syrian Arab Republic</option>
          <option value="TWN">Taiwan, Province of China</option>
          <option value="TJK">Tajikistan</option>
          <option value="TZA">Tanzania, United Republic of</option>
          <option value="THA">Thailand</option>
          <option value="TLS">Timor-Leste</option>
          <option value="TGO">Togo</option>
          <option value="TKL">Tokelau</option>
          <option value="TON">Tonga</option>
          <option value="TTO">Trinidad and Tobago</option>
          <option value="TUN">Tunisia</option>
          <option value="TUR">Turkey</option>
          <option value="TKM">Turkmenistan</option>
          <option value="TCA">Turks and Caicos Islands</option>
          <option value="TUV">Tuvalu</option>
          <option value="UGA">Uganda</option>
          <option value="UKR">Ukraine</option>
          <option value="ARE">United Arab Emirates</option>
          <option value="GBR">United Kingdom</option>
          <option value="UMI">United States Minor Outlying Islands</option>
          <option value="URY">Uruguay</option>
          <option value="UZB">Uzbekistan</option>
          <option value="VUT">Vanuatu</option>
          <option value="VEN">Venezuela, Bolivarian Republic of</option>
          <option value="VNM">Viet Nam</option>
          <option value="VGB">Virgin Islands, British</option>
          <option value="VIR">Virgin Islands, U.S.</option>
          <option value="WLF">Wallis and Futuna</option>
          <option value="ESH">Western Sahara</option>
          <option value="YEM">Yemen</option>
          <option value="ZMB">Zambia</option>
          <option value="ZWE">Zimbabwe</option>
        </select></div>
      <div class="col mb-3 divContactField" id="divContactField_10"><label for="email_address">Email Address* <span class="error"></span></label><input type="text" name="email_address" class="form-control" id="email_address" placeholder=""
          data-validate="required email" data-contact-label="Email Address"></div>
      <div class="col mb-3 divContactField" id="divContactField_11"><label for="confirm_email_address">Confirm Email Address* <span class="error"></span></label><input type="text" name="confirm_email_address" class="form-control"
          id="confirm_email_address" placeholder="" data-validate="required email" data-contact-label="Confirm Email Address"></div>
      <div class="col mb-3 divContactField" id="divContactField_12"><label for="phone_number_1">Phone 1 <span class="error"></span></label><input type="tel" name="phone_number_1" class="form-control" id="phone_number_1"
          placeholder="Example: 855-556-2233" data-validate=" phone" data-contact-label="Phone 1"></div>
      <div class="col mb-3 divContactField" id="divContactField_13"><label for="phone_number_2">Phone 2 <span class="error"></span></label><input type="tel" name="phone_number_2" class="form-control" id="phone_number_2"
          placeholder="Example: 855-556-2233" data-validate=" phone" data-contact-label="Phone 2"></div>
    </div>
  </fieldset>
  <fieldset class="bg-light text-dark border rounded p-3 mb-5" id="claim-fields">
    <legend>Details</legend>
    <p></p>
    <div>
      <div class="mb-3"><label for="select_field_us_reside_0">Did you reside in the United States at any time between May 24, 2007 and December 22, 2022, inclusive?* <span class="error"></span></label><select name="select_field_us_reside"
          class="form-control" id="select_field_us_reside_0" data-validate="required " data-label="Did you reside in the United States at any time between May 24, 2007 and December 22, 2022, inclusive?">
          <option value="">SELECT</option>
          <option value="YES">YES</option>
          <option value="NO">NO</option>
        </select></div>
      <div class="mb-3"><label for="select_field_fb_user_1">Were you a Facebook user at any time between May 24, 2007 and December 22, 2022?* <span class="error"></span></label><select name="select_field_fb_user" class="form-control"
          id="select_field_fb_user_1" data-validate="required " data-label="Were you a Facebook user at any time between May 24, 2007 and December 22, 2022?">
          <option value="">SELECT</option>
          <option value="YES">YES</option>
          <option value="NO">NO</option>
        </select></div>
      <div class="mb-3"><label for="select_active_and_or_deleted_acct_2">Are you filing a claim for a current account, a deleted account or a combination of both?* <span class="error"></span></label><select name="select_active_and_or_deleted_acct"
          class="form-control" id="select_active_and_or_deleted_acct_2" data-validate="required " data-label="Are you filing a claim for a current account, a deleted account or a combination of both?">
          <option value="">SELECT</option>
          <option value="Current Account(s)">Current Account(s)</option>
          <option value="Deleted Account(s)">Deleted Account(s)</option>
          <option value="Both Current and Deleted Accounts">Both Current and Deleted Accounts</option>
        </select></div>
      <div class="mb-3"><input type="hidden" name="payment_method" id="payment_method" data-label="Payment Method"></div>
      <div class="mb-3"><input type="hidden" name="payment_token" id="payment_token" data-label="Payment Token"></div>
      <div class="mb-3"><input type="hidden" name="payment_email" id="payment_email" data-label="Payment Email"></div>
      <div class="mb-3"><input type="hidden" name="payment_phone" id="payment_phone" data-label="Payment Phone"></div>
    </div>
  </fieldset>
  <fieldset class="bg-light text-dark border rounded p-3 mb-5" id="transactions">
    <legend class="mb-3">Your Facebook Account</legend>
    <p class="mb-3">Enter <strong>all known</strong> email address(es), phone number(s), and/or username(s) associated with your Facebook account between May 24, 2007 and December 22, 2022. Each Settlement Class Member may only file one claim.</p>
    <div class="table-responsive mb-3 d-none" id="table_responsive_1">
      <h4 class="table-title mb-3" id="table_title_1">Current Username(s)</h4>
      <p class="table-paragraph mb-3" id="table_description_1">To find your username, please see <a href="#faqs?id=17" target="_blank" class="fw-bold">FAQ 17</a>.</p>
      <table class="table table-hover transactions" id="transactions_1">
        <caption style="display:none;">To find your username, please see <a href="#faqs?id=17" target="_blank" class="fw-bold">FAQ 17</a>.</caption>
        <thead class="table-dark text-light">
          <tr>
            <th scope="col">Username</th>
          </tr>
        </thead>
        <tbody>
          <tr>
            <td class="transaction account_username">
              <div><input type="text" name="account_username_1_1" class="form-control" id="account_username_1_1" data-validate="" data-label="Username" item-id="1"><label for="account_username_1_1" class="fs-6">Username <span
                    class="error"></span></label></div>
            </td>
          </tr>
        </tbody>
      </table>
    </div>
    <p class="text-center"><a class="btn btn-primary d-none" id="add_transactions_1" tableid="1"><i class="bi bi-plus-circle" tableid="1"></i> Current Username(s)</a></p>
    <div class="table-responsive mb-3 d-none" id="table_responsive_2">
      <h4 class="table-title mb-3" id="table_title_2">Current Email(s)</h4>
      <p class="table-paragraph mb-3" id="table_description_2"></p>
      <table class="table table-hover transactions" id="transactions_2">
        <caption style="display:none;"></caption>
        <thead class="table-dark text-light">
          <tr>
            <th scope="col">Email(s)</th>
          </tr>
        </thead>
        <tbody>
          <tr>
            <td class="transaction account_email">
              <div><input type="email" name="account_email_2_1" class="form-control" id="account_email_2_1" data-validate=" email" data-label="Email Address" item-id="1"><label for="account_email_2_1" class="fs-6">Email Address <span
                    class="error"></span></label></div>
            </td>
          </tr>
        </tbody>
      </table>
    </div>
    <p class="text-center"><a class="btn btn-primary d-none" id="add_transactions_2" tableid="2"><i class="bi bi-plus-circle" tableid="2"></i> Current Email(s)</a></p>
    <div class="table-responsive mb-3 d-none" id="table_responsive_3">
      <h4 class="table-title mb-3" id="table_title_3">Current Phone Number(s)</h4>
      <p class="table-paragraph mb-3" id="table_description_3"></p>
      <table class="table table-hover transactions" id="transactions_3">
        <caption style="display:none;"></caption>
        <thead class="table-dark text-light">
          <tr>
            <th scope="col">Phone Number(s)</th>
          </tr>
        </thead>
        <tbody>
          <tr>
            <td class="transaction account_phone">
              <div><input type="tel" name="account_phone_3_1" class="form-control" id="account_phone_3_1" data-validate=" phone" data-label="Phone Number" item-id="1"><label for="account_phone_3_1" class="fs-6">Phone Number <span
                    class="error"></span></label></div>
            </td>
          </tr>
        </tbody>
      </table>
    </div>
    <p class="text-center"><a class="btn btn-primary d-none" id="add_transactions_3" tableid="3"><i class="bi bi-plus-circle" tableid="3"></i> Current Phone Number(s)</a></p>
    <div class="table-responsive mb-3 d-none" id="table_responsive_4">
      <h4 class="table-title mb-3" id="table_title_4">Your Deleted Account(s)</h4>
      <p class="table-paragraph mb-3" id="table_description_4">If you were a Facebook user at any time between May 24, 2007 and December 22, 2022, but have since deleted your account:</p>
      <table class="table table-hover transactions" id="transactions_4">
        <caption style="display:none;">If you were a Facebook user at any time between May 24, 2007 and December 22, 2022, but have since deleted your account:</caption>
        <thead class="table-dark text-light">
          <tr>
            <th scope="col">Account ID Type</th>
            <th scope="col">Profile Information</th>
            <th scope="col">Date Start</th>
            <th scope="col">Date End</th>
          </tr>
        </thead>
        <tbody>
          <tr>
            <td class="transaction account_type_upe">
              <div class="form-group"><select name="account_type_upe_4_1" class="form-control" id="account_type_upe_4_1" item-id="1" data-validate="" data-label="Account ID Type">
                  <option value="">SELECT</option>
                  <option value="Username">Username</option>
                  <option value="Phone Number">Phone Number</option>
                  <option value="Email">Email</option>
                </select><label class="fs-6" for="account_type_upe_4_1">Account ID Type <span class="error"></span></label></div>
            </td>
            <td class="transaction account_profile_information">
              <div><input type="text" name="account_profile_information_4_1" class="form-control" id="account_profile_information_4_1" data-validate="" data-label="Username, Email, or Phone" item-id="1"><label for="account_profile_information_4_1"
                  class="fs-6">Username, Email, or Phone <span class="error"></span></label></div>
            </td>
            <td class="transaction start_date">
              <div class="form-group"><input type="date" name="start_date_4_1" class="form-control" id="start_date_4_1" data-validate="date date-min date-max" data-label="Start Date (Approximate)" data-date-format="YYYY-MM-DD"
                  data-date-min="2007-05-24" data-date-max="2022-12-22" item-id="1"><label class="fs-6" for="start_date_4_1">Start Date (Approximate) <span class="error"></span></label></div>
            </td>
            <td class="transaction end_date">
              <div class="form-group"><input type="date" name="end_date_4_1" class="form-control" id="end_date_4_1" data-validate="date date-min date-max" data-label="End Date (Approximate)" data-date-format="YYYY-MM-DD" data-date-min="2007-05-24"
                  data-date-max="2022-12-22" item-id="1"><label class="fs-6" for="end_date_4_1">End Date (Approximate) <span class="error"></span></label></div>
            </td>
          </tr>
        </tbody>
      </table>
    </div>
    <p class="text-center"><a class="btn btn-primary d-none" id="add_transactions_4" tableid="4"><i class="bi bi-plus-circle" tableid="4"></i> Your Deleted Account(s)</a></p>
  </fieldset>
  <fieldset class="bg-light text-dark border rounded p-3 mb-5">
    <legend>Method for Receiving Payment</legend>
    <p class="fw-bold text-center text-danger">Please make sure the email or phone number you provide to receive payment matches your contact information above.</p>
    <p class="d-none text-center" id="update_payment_message">You have successfully requested a <span id="previous_payment_method"></span> payment. <span id="update_payment_toggle">Click here if you would like to choose a different payment
        method.</span></p>
    <div id="dst-payment" key="c0a312956f96110f801f1df5bf19bb7fbd072816ab2992fa63cda82bce2f5e08"><iframe frameborder="0"
        src="https://content.digitaldisbursements.com/v1.4.3/index.html?c0a312956f96110f801f1df5bf19bb7fbd072816ab2992fa63cda82bce2f5e08&amp;%7B%22verify%22%3Afalse%7D"
        style="border: none; width: 100%; height: 378px; overflow: hidden;"></iframe><iframe frameborder="0"
        src="https://content.digitaldisbursements.com/v1.4.3/index.html?c0a312956f96110f801f1df5bf19bb7fbd072816ab2992fa63cda82bce2f5e08&amp;%7B%22params%22%3A%7B%22verify%22%3Afalse%7D%2C%22flow%22%3A%22shared-data%22%7D"
        style="border: none; width: 0px; height: 0px; overflow: hidden;"></iframe></div>
    <script type="text/javascript">
      dstPaymentForm(document.getElementById('dst-payment'), {
        verify: false,
        onSubmitted: function(info) {
          document.getElementById('payment_method').value = info.method;
          document.getElementById('payment_token').value = info.token;
          if (info.paymentEmail) {
            document.getElementById('payment_email').value = info.paymentEmail;
          }
          if (info.paymentPhone) {
            document.getElementById('payment_phone').value = info.paymentPhone;
          }
        }
      })
    </script>
  </fieldset>
  <fieldset class="bg-light text-dark border rounded p-3 mb-5" id="certification">
    <legend class="mb-3">Verification And Attestation Under Oath</legend>
    <p class="mb-3">By submitting this Claim Form, I hereby swear under penalty of perjury that I am the person identified above and the information provided in this Claim Form is true and correct.</p>
    <div class="row">
      <div class="col-md-5"><input type="text" name="signature" class="form-control" id="signature" data-validate="required" data-contact-label="Signature" placeholder="TYPE YOUR FULL NAME"><label for="signature">Your Name *<span
            class="error"></span></label></div>
      <div class="col-md-5"><input type="text" name="date" class="form-control" id="date" data-validate="required" data-contact-label="Date" disabled="disabled" value="8/19/2023, 9:45:13 PM"><label for="date">Date <span class="error"></span></label>
      </div>
      <div class="col-md-2">
        <div class="d-grid"><input type="hidden" id="site_id" value="6LeVdgEVAAAAAGLdvtrwMCDZcDZzJ300FZHqvmud"><input type="hidden" name="ag_UUID" id="ag_UUID" value="bb3d928bd8a35321fd49ac807dce0f21"><input type="hidden" name="referer_url"
            id="referer_url" value="undefined"><input type="hidden" name="user_language" id="user_language" value="en"><input type="submit" class="btn btn-primary" id="submit-claim" value="Submit"></div>
      </div>
    </div>
  </fieldset>
</form>

Text Content

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IN RE: FACEBOOK, INC. CONSUMER PRIVACY USER PROFILE LITIGATION


CASE NO. 3:18-MD-02843-VC


UNITED STATES DISTRICT COURT FOR THE NORTHERN DISTRICT OF CALIFORNIA

MENUSubmit Claim
 * Home
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 * FAQs
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Filed a claim? Click here to edit your claim.


THE DEADLINE FOR SUBMITTING THIS CLAIM FORM IS
AUGUST 25, 2023 AT 11:59 PM PT

Please add the email, Confirmation@FacebookUserPrivacySettlement.com, to your
contact list to ensure that future correspondence is delivered to your inbox.
Click for General Instructions

This Claim Form is for Settlement Class Members. The Settlement Class includes
the following: All Facebook users in the United States between May 24, 2007 and
December 22, 2022. To receive a payment from the Settlement, you must complete
and submit this form.

How To Complete This Claim Form

 1. There are two ways to submit this Claim Form to the Settlement
    Administrator: (a) online on this website; or (b) by U.S. Mail to the
    following address: Facebook Consumer Privacy User Profile Litigation, c/o
    Settlement Administrator, 1650 Arch Street, Suite 2210, Philadelphia, PA
    19103. Your Claim Form must be submitted by August 25, 2023. If you submit
    your claim by U.S. mail, make sure the completed and signed Claim Form is
    postmarked by August 25, 2023.
 2. You must complete the entire Claim Form. Please type or write your responses
    legibly.
 3. If your Claim Form is incomplete or missing information, the Settlement
    Administrator may contact you for additional information. If you do not
    respond by the deadline provided by the Settlement Administrator for you to
    supply any such additional information, your claim will not be processed,
    and you will waive your right to receive money under the Settlement.
 4. You may only submit one Claim Form.
 5. Submission of the Claim Form does not guarantee payment. Your Claim Form
    must be approved by the Settlement Administrator.
 6. If you have any questions, please contact the Settlement Administrator by
    email at info@FacebookUserPrivacySettlement.com, by telephone at
    1-855-556-2233 or by U.S. mail at the address listed above.
 7. You must notify the Settlement Administrator if your contact or payment
    information changes after you submit your Claim Form. If you do not, even if
    you submit a valid claim under the Settlement, you may not receive your
    Settlement payment.
 8. DEADLINE -- If you submit a claim by U.S. mail, the completed and signed
    Claim Form must be postmarked by August 25, 2023. If submitting a Claim Form
    online, you must do so by August 25, 2023 at 11:59 p.m. PDT.

Your Contact Information



Provide your name and contact information below. You must notify the Settlement
Administrator if your contact information changes after you submit this form.
NOTE: The personal information you provide below will be processed only for
purposes of effectuating the Settlement.

* Required Fields



First Name*
Last Name*
Street Address 1*
Street Address 2
City*
State*
SELECTAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict
Of
ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew
HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth
DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth
DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest
VirginiaWisconsinWyomingPuerto RicoGuamAmerican SamoaNorthern Mariana
IslandsU.S. Virgin IslandsAA (Armed Forces Americas)AE (Armed Forces Europe)AP
(Armed Forces Pacific)
Province
Zip Code*
Postal Code
Country* SELECTUnited StatesAfghanistanÅland IslandsAlbaniaAlgeriaAmerican
SamoaAndorraAngolaAnguillaAntarcticaAntigua and
BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia,
Plurinational State ofBonaire, Sint Eustatius and SabaBosnia and
HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei
DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman
IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling)
IslandsColombiaComorosCongoCongo, the Democratic Republic of theCook
IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech
RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl
SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe
IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern
TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard
Island and McDonald IslandsHoly See (Vatican City State)HondurasHong
KongHungaryIcelandIndiaIndonesiaIran, Islamic Republic ofIraqIrelandIsle of
ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic
People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic
RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedonia,
the former Yugoslav Republic ofMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall
IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia, Federated States
ofMoldova, Republic
ofMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew
CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana
IslandsNorwayOmanPakistanPalauPalestinian Territory, OccupiedPanamaPapua New
GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto
RicoQatarRéunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena,
Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin
(French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan
MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra
LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon
IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth
SudanSpainSri LankaSudanSurinameSvalbard and Jan
MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwan, Province of
ChinaTajikistanTanzania, United Republic
ofThailandTimor-LesteTogoTokelauTongaTrinidad and
TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited
Arab EmiratesUnited KingdomUnited States Minor Outlying
IslandsUruguayUzbekistanVanuatuVenezuela, Bolivarian Republic ofViet NamVirgin
Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern
SaharaYemenZambiaZimbabwe
Email Address*
Confirm Email Address*
Phone 1
Phone 2
Details



Did you reside in the United States at any time between May 24, 2007 and
December 22, 2022, inclusive?* SELECTYESNO
Were you a Facebook user at any time between May 24, 2007 and December 22,
2022?* SELECTYESNO
Are you filing a claim for a current account, a deleted account or a combination
of both?* SELECTCurrent Account(s)Deleted Account(s)Both Current and Deleted
Accounts




Your Facebook Account

Enter all known email address(es), phone number(s), and/or username(s)
associated with your Facebook account between May 24, 2007 and December 22,
2022. Each Settlement Class Member may only file one claim.

CURRENT USERNAME(S)

To find your username, please see FAQ 17.

To find your username, please see FAQ 17.Username
Username

Current Username(s)

CURRENT EMAIL(S)



Email(s)
Email Address

Current Email(s)

CURRENT PHONE NUMBER(S)



Phone Number(s)
Phone Number

Current Phone Number(s)

YOUR DELETED ACCOUNT(S)

If you were a Facebook user at any time between May 24, 2007 and December 22,
2022, but have since deleted your account:

If you were a Facebook user at any time between May 24, 2007 and December 22,
2022, but have since deleted your account:Account ID TypeProfile InformationDate
StartDate End
SELECTUsernamePhone NumberEmailAccount ID Type
Username, Email, or Phone
Start Date (Approximate)
End Date (Approximate)

Your Deleted Account(s)

Method for Receiving Payment

Please make sure the email or phone number you provide to receive payment
matches your contact information above.

You have successfully requested a payment. Click here if you would like to
choose a different payment method.


Verification And Attestation Under Oath

By submitting this Claim Form, I hereby swear under penalty of perjury that I am
the person identified above and the information provided in this Claim Form is
true and correct.

Your Name *
Date

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